MedNet Egypt is one of the leading managed care service organizations that cater to healthcare needs. We are looking for skilled Team Leader – Utilization Management who will beresponsible for leading and overseeing the utilization management, burning cost and loss ratio analysis function to ensure early identification of cost drivers, abnormal billing patterns, and potential fraud, waste, and abuse (FWA) across all insurance policies.Your Job:Lead and oversee the Utilization Management team, ensuring prioritization, quality, and timely delivery.Review, validate, and challenge utilization analyses before escalation.Provide coaching, technical guidance, and performance feedback to team members.Closely monitor burning cost and loss ratio across products and policies.Govern utilization management frameworks across policies, provider networks, and benefit structures.Analyze utilization trends to identify cost drivers, emerging risks, and high-impact members, providers, clinicians, and services.Translate analytical insights into utilization control actions and corrective recommendations.Oversee identification of billing abnormalities and abnormal utilization behaviors (e.g., overutilization, upcoding, LOS, duplicates).Validate high-risk cases and manage escalation to FWA, QA, Claims, Approvals, and Network teams.Act as the utilization subject-matter expert in FWA and payment integrity discussions.Lead development of utilization analytics, business rules, flags, triggers, and provider outlier detection models.Establish dashboards and reports for burning cost, loss ratio, utilization risks, trends, and variances, present insights to management.Coordinate cross-functionally with Claims, QA, FWA, Rule Engine, Network teams, and support governance committees and provider communications.Your Profile:Education:Bachelor’s degree in medical, Paramedical, Insurance, Healthcare Management, or related field.5+ years’ experience in utilization management, claims analytics, provider network management and provider audit.Minimum 2 years in a lead or supervisory role within a health insurance or TPA environmentAwareness of local regulatory requirements and UAE market is preferred.Strong understanding of medical billing and coding, insurance benefits and utilization controls, FWA patterns and payment integrity conceptsAdvanced analytical and decision-making skillsLeadership, coaching, and stakeholder management skillsHigh professional judgment and accountability